Page:Representation of the Peoples Act 1918 (ukpga 19180064).pdf/59

1918. (Name of University)

No. (number of elector as on the register).

I, A.B. (here give the elector's name in full and his designation), give my vote as indicated below:—

I declare that I have signed no other voting paper at this election for the combined university constituency of the University of St. Andrews, the University of Glasgow, the University of Aberdeen, and the University of Edinburgh.

I also declare—

(In the case of a man) that I have not voted at this general election in respect of any qualification other than a residence qualification;

(In the case of a woman) that I have not voted at this general election for any other university constituency.

Signed A.B.

Address

The day of  19.

I declare that this voting paper (the vote having been previously recorded thereon), was signed in my presence hy A.B ., who is personally known to me, day of   on the 19

Signed C.D.

Designation

Address